Protein C zymogen in severe sepsis: a double-blinded, placebo-controlled, randomized study

Abstract

Protein C zymogen did not improve clinically relevant outcomes in severe sepsis and septic shock adult patients. Given its high cost and the potential increase in mortality, the use of this drug in adult patients should be discouraged.

Variation of endothelium‐related hemostatic factors during sepsis

“…The importance of the thrombomodulin/activated protein C system in preserving blood clotting homeostasis and the functional integrity of microcirculation has been largely recognized, and it has been shown that this system is compromised in DIC caused by sepsis . Although it was assumed that the reconstitution of the protein C/thrombomodulin system could alleviate the symptoms of sepsis‐related DIC, the use of rhAPC failed to improve clinical outcomes . Thrombomodulin has been used in patients with sepsis‐related DIC, but definite conclusions about its clinical efficacy are awaited, with the completion of a randomized controlled trial (phase III study) which is underway .…”

“…6 Although it was assumed that the reconstitution of the protein C/thrombomodulin system could alleviate the symptoms of sepsis-related DIC, the use of rhAPC failed to improve clinical outcomes. 7,8 Thrombomodulin has been used in patients with sepsis-related DIC, but definite conclusions about its clinical efficacy are awaited, with the completion of a randomized controlled trial (phase III study) which is underway. 9 Recently, the system of VWF and a disintegrin and metalloprotease with thrombospondin type motifs 13 (ADAMTS-13) has also been implicated in the pathogenesis of organ dysfunction in sepsis.…”

A Pathophysiological Perspective on the SARS‐CoV‐2 Coagulopathy

“…The anticoagulant effect of aPC is well defined, however its use in microangiopathic patients, such as in sepsis, did not improve outcome. 44 , 45 Third crosstalk is at the level of fibrinolysis where aPC has been suggested to neutralize fibrinolysis inhibitors TAFI and PAI-1 resulting in the activation of the fibrinolysis. 46 Decreased levels of aPC might in turn limit the fibrinolytic response.…”

ICM focus on thrombosis and bleeding

“…An Italian single-centre RCT (n = 38) assessed use of protein C zymogen vs. placebo in high-risk ICU patients with severe sepsis/septic shock [15]. The study was stopped early because of safety issues: the composite primary outcome of prolonged ICU stay and 30-day mortality was 79 vs. 67%, in-ICU mortality was 79 vs. 39%, and 30-day mortality was 68 vs 39% in the protein C zymogen group vs the placebo group.…”